1+ months

Sr Clinical Coding RN Consultant WellMed McAllen RGV TX - 925773

McAllen, TX 78501
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  • Job Code
    925773

Do you have compassion and a passion to help others? Transforming healthcare and millions of lives as a result starts with the values you embrace and the passion you bring to achieve your lifes best work.(sm)

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The Sr. Clinical Coding Nurse Consultant will drive consistent, efficient processes and share best practices in a collaborative effort with Providers and Market Team, designed to facilitate achievement of goals set for HCC Ratio, HCC Covered Ratio, and HCC Percent Covered. The Sr. Clinical Coding Nurse Consultant will drive Risk Adjustment improvement initiatives, develop recommendations for Risk Adjustment remediation plans and create tools and databases to capture relevant data for assigned markets to achieve corporate and market specific Risk Adjustment goals and initiatives. This position will work collaboratively with each regional / market team and their leadership in a matrix relationship. This position will provide direction and guidance to Medical Coding Analysts, as well as cross functional team members within their respective Markets pertaining to Risk Adjustment.

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There is a $5,000 sign-on bonus for qualified externalcandidates

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This position will require travel to WellMed clinics meeting with providers.

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Primary Responsibilities:

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  • Develop and implement market business plans to motivate providers to engage in improving Risk Adjustment metrics
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  • Provide analytical interpretation of Risk Adjustment reporting including, Executive Summaries, HCC Ratio, Disagree and Resolution rates, and FaxBack reporting to plan and provider groups
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  • Subject Matter Expert (SME) for all Risk Adjustment related activities within their assigned market(s) working within a matrix relationship which includes DataRAP operations and Regional / Market operations
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  • Assist in developing of training and analytical materials for Risk Adjustment
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  • Oversee DataRAP training and education delivery for Mega Groups via Provider education sessions and Physician Business Meetings / JOCs
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  • Lead Weekly, Monthly, Bi - monthly, Quarterly, and / or Annual Business Review meetings related to Risk Adjustment activities which summarize provider group performance and market performance as requested by or required by Market leadership
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  • Analyze and evaluate provider group structure and characteristics, provider group / provider office operations and personnel to identify the most effective approaches and strategies related to Risk Adjustment
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  • Analyze Provider and Group performance regarding Risk Adjustment and Focus on Care (FOC) to determine areas of focus or improvement opportunities
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  • Develop solution-based, user friendly initiatives to support practice success
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  • Oversee market specific chart retrieval and review of PCP, Hospital, and Specialist records
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  • Work with DataRAP Senior Leadership on identified special projects
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Youll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

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Required Qualifications:

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  • Bachelors degree in Nursing (Associate degree or Nursing Diploma from accredited nursing school with 2+ years of additional experience may be substituted in lieu of a bachelors degree) and current RN license in good standing
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  • CPC certification or proof that certification has been obtained within 9 months from the American Academy of Professional Coders
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  • 1+ years of ICD-9, ICD10 coding experience
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  • 5+ years of associated business experience with health care industry
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  • Knowledge of CMS HCC Model and Guidelines along with ICD 10 Guidelines
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  • Professional experience persuading changes in behavior
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  • Strong knowledge of the Medicare market, products and competitors
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  • Knowledge base of clinical standards of care and preventative health measures
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  • Ability and willingness to travel (locally and non - locally) as determined by business needs
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  • You will be provisioned with appropriate Personal Protective Equipment (PPE) and are required to perform this role with patients and members on site, as this is an essential function of this role
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  • Employees are required to screen for symptoms using the ProtectWell mobile app, Interactive Voice Response (i.e., entering your symptoms via phone system) or a similar UnitedHealth Group-approved symptom screener prior to entering the work site each day, in order to keep our work sites safe. Employees must comply with any state and local masking orders. In addition, when in a UnitedHealth Group building, employees are expected to wear a mask in areas where physical distancing cannot be attained
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Preferred Qualifications:

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  • Experience in managed care working with network and provider relations
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  • Strong presentation skills and relationship building skills with clinical / non-clinical personnel
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  • Demonstrated ability to interact with medical staff, peers, and internal company staff at all levels
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  • Ability to solve process problems crossing multiple functional areas and business units
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  • Strong problem - solving skills; the ability to analyze problems, draw relevant conclusions and devise and implement an appropriate plan of action
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  • Good business acumen, especially as it relates to Medicare
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  • Medical / clinical background highly desirable
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  • Undergraduate degree preferred
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  • MS Office Suite, moderate to advanced Excel and PowerPoint skills
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  • Additional Medical chart review experience
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Physical and Mental Requirements:

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  • Ability to lift up to 10 pounds
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  • Ability to push or pull heavy objects using up to pounds of force
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  • Ability to sit for extended periods of time
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  • Ability to stand for extended periods of time
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  • Ability to use fine motor skills to operate equipment and / or machinery
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  • Ability to properly drive and operate a company vehicle
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  • Ability to receive and comprehend instructions verbally and / or in writing
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  • Ability to use logical reasoning for simple and complex problem solving
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Careers with WellMed. Our focus is simple. We're innovators in preventative health care, striving to change the face of health care for seniors. We're impacting 550,000+ lives, primarily Medicare eligible seniors in Texas and Florida, through primary and multi-specialty clinics, and contracted medical management services. We've joined Optum, part of the UnitedHealth Group family of companies, and our mission is to help the sick become well and to help patients understand and control their health in a lifelong effort at wellness. Our providers and staff are selected for their dedication and focus on preventative, proactive care. For you, that means one incredible team and a singular opportunity to do your life's best work.(sm)

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Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

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UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

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Job Keywords: Senior Clinical Coding RN Consultant, Clinical Coding, RN, WellMed, Rio Grande Valley, Alice, McAllen, TX, Texas

Posted: 2021-04-29 Expires: 2021-09-23

UnitedHealth Group is the most diversified health care company in the United States and a leader worldwide in helping people live healthier lives and helping to make the health system work better for everyone.

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Sr Clinical Coding RN Consultant WellMed McAllen RGV TX - 925773

UnitedHealth Group
McAllen, TX 78501

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